My Sister's Keeper

by Jodi Picoult

  He puts in an IV line while I pick up the radio and call in our ETA. "Thirteen-year-old female, MVA, severe closed head injury . . . " When the cardiac monitor blanks out, I drop the receiver and start CPR. "Get the paddles," I order, and I pull open Anna's shirt, cut through the lace of the bra she wanted so badly but doesn't need. Red shocks her, and gets the pulse back, bradycardia with ventricular escape beats.

  We bag her and put in an IV. Paulie screams into the loading zone for ambulances and throws open the back doors. On the trailer, Anna is immobile. Red grabs my arm, hard. "Don't think about it," he says, and he takes the head of Anna's stretcher and rushes her into the ER.

  They will not let me into the trauma room. A flock of firefighters dribble in for support. One of them goes up to get Sara, who arrives frantic. "Where is she? What happened?"

  "A car accident," I manage. "I didn't know who it was until I got there." My eyes fill up. Do I tell her that she is not breathing independently? Do I tell her that the EKG flatlined? Do I tell her that I have spent the past few minutes questioning every single thing I did on that call, from the way I crawled over the truck to the moment I pulled her from the wreckage, certain that my emotion compromised what should have been done, what could have been done?

  At that moment I hear Campbell Alexander, and the sound of something being thrown against a wall. "Goddammit," he says. "Just tell me whether or not she was brought here!"

  He bursts out of the doorway of another trauma room, his arm in a cast, his clothes bloodied. The dog, limping, is at his side. Immediately, Campbell's eyes home in on mine. "Where's Anna?" he asks.

  I don't answer, because what the hell can I say. And that's all it takes for him to understand. "Oh, Jesus," he whispers. "Oh God, no."

  The doctor comes out of Anna's room. He knows me; I am here four nights a week. "Brian," he says soberly, "she's not responding to noxious stimuli."

  The sound that comes out of me is primal, inhuman, all-knowing. "What does that mean?" Sara's words peck at me. "What is he saying, Brian?"

  "Anna's head hit the window with great force, Mrs. Fitzgerald. It caused a fatal head injury. A respirator is keeping her breathing right now, but she's not showing any indications of neurological activity . . . she's brain dead. I'm sorry," the doctor says. "I really am." He hesitates, looks from me to Sara. "I know it's not something you even want to think about right now, but there's a very small window . . . is organ donation something you'd like to consider?"

  *

  There are stars in the night sky that look brighter than the others, and when you look at them through a telescope you realize you are looking at twins. The two stars rotate around each other, sometimes taking nearly a hundred years to do it. They create so much gravitational pull there's no room around for anything else. You might see a blue star, for example, and realize only later that it has a white dwarf as a companion--that first one shines so bright, by the time you notice the second one, it's really too late.

  *

  Campbell is the one who actually answers the doctor. "I have power of attorney for Anna," he explains, "not her parents." He looks from me, to Sara. "And there is a girl upstairs who needs that kidney."

  SARA

  IN THE ENGLISH LANGUAGE there are orphans and widows, but there is no word for the parent who loses a child.

  They bring her back down to us after the donated organs are removed. I am the last to go in. In the hallway, already, are Jesse and Zanne and Campbell and some of the nurses we've grown close to, and even Julia Romano--the people who needed to say goodbye.

  Brian and I walk inside, where Anna lies tiny and still on the hospital bed. A tube feeds down her throat, a machine breathes for her. It is up to us to turn it off. I sit down on the edge of the bed and pick up Anna's hand, still warm to the touch, still soft inside mine. It turns out that after all these years I have spent anticipating a moment like this, I am completely at a loss. Like coloring the sky in with a crayon; there is no language for grief this big. "I can't do this," I whisper.

  Brian comes up behind me. "Sweetheart, she's not here. It's the machine keeping her body alive. What makes Anna Anna is already gone."

  I turn, bury my face against his chest. "But she wasn't supposed to," I sob.

  We hold each other, then, and when I feel brave enough I look back down at the husk that once held my youngest. He is right, after all. This is nothing but a shell. There is no energy to the lines of her face; there is a slack absence to her muscles. Under this skin they have stripped her of organs that will go to Kate and to other, nameless, second-chance people.

  "Okay." I take a deep breath. I put my hand on Anna's chest as Brian, trembling, flips off the respirator. I rub her skin in small circles, as if this might make it easier. When the monitors flatline, I wait to see some change in her. And then I feel it, as her heart stops beating beneath my palm--that tiny loss of rhythm, that hollow calm, that utter loss.

  EPILOGUE

  When along the pavement,

  Palpitating flames of life,

  People flicker round me,

  I forget my bereavement,

  The gap in the great constellation,

  The place where a star used to be.

  --D. H. LAWRENCE,

  "Submergence"

  Kate

  2010

  THERE SHOULD BE A STATUTE of limitation on grief. A rule book that says it is all right to wake up crying, but only for a month. That after forty-two days you will no longer turn with your heart racing, certain you have heard her call out your name. That there will be no fine imposed if you feel the need to clean out her desk; take down her artwork from the refrigerator; turn over a school portrait as you pass--if only because it cuts you fresh again to see it. That it is okay to measure the time she has been gone, the way we once measured her birthdays.

  For a long time, afterward, my father claimed to see Anna in the night sky. Sometimes it was the wink of her eye, sometimes the shape of her profile. He insisted that stars were people who were so well loved they were traced in constellations, to live forever. My mother believed, for a long time, that Anna would come back to her. She began to look for signs--plants that bloomed too early, eggs with double yolks, salt spilled in the shape of letters.

  And me, well, I began to hate myself. It was, of course, all my fault. If Anna had never filed that lawsuit, if she hadn't been at the courthouse signing papers with her attorney, she never would have been at that particular intersection at that particular moment. She would be here, and I would be the one coming back to haunt her.

  *

  For a long time, I was sick. The transplant nearly failed, and then, inexplicably, I began the long steep climb upward. It has been eight years since my last relapse, something not even Dr. Chance can understand. He thinks it is a combination of the ATRA and the arsenic therapy--some contributing delayed effect--but I know better. It is that someone had to go, and Anna took my place.

  Grief is a curious thing, when it happens unexpectedly. It is a Band-Aid being ripped away, taking the top layer off a family. And the underbelly of a household is never pretty, ours no exception. There were times I stayed in my room for days on end with headphones on, if only so that I would not have to listen to my mother cry. There were the weeks that my father worked round-the-clock shifts, so that he wouldn't have to come home to a house that felt too big for us.

  Then one morning, my mother realized that we had eaten everything in the house, down to the last shrunken raisin and graham cracker crumb, and she went to the grocery store. My father paid a bill or two. I sat down to watch TV and watched an old I Love Lucy and started to laugh.

  Immediately, I felt like I had defiled a shrine. I clapped my hand over my mouth, embarrassed. It was Jesse, sitting beside me on the couch, who said, "She would have thought it was funny, too."

  See, as much as you want to hold on to the bitter sore memory that someone has left this world, you are still in it. And the very act of living is a tide: a
t first it seems to make no difference at all, and then one day you look down and see how much pain has eroded.

  *

  I wonder how much she keeps tabs on us. If she knows that for a long time, we were close to Campbell and Julia, even went to their wedding. If she understands that the reason we don't see them anymore is because it just plain hurt too much, because even when we didn't talk about Anna, she lingered in the spaces between the words, like the smell of something burning.

  I wonder if she was at Jesse's graduation from the police academy, if she knows that he won a citation from the mayor last year for his role in a drug bust. I wonder if she knew that Daddy fell deep into a bottle after she left, and had to claw his way out. I wonder if she knows that, now, I teach children how to dance. That every time I see two little girls at the barre, sinking into plies, I think of us.

  *

  She still takes me by surprise. Like nearly a year after her death, when my mother came home with a roll of film she'd just developed of my high school graduation. We sat down at the kitchen table together, shoulder to shoulder, trying not to mention as we looked at all our double-wide grins that there was someone missing from the photo.

  And then, as if we'd conjured her, the last picture was of Anna. It had been that long since we'd used the camera, plain and simple. She was on a beach towel, holding out one hand toward the photographer, trying to get whoever it was to stop taking her picture.

  My mother and I sat at the kitchen table staring at Anna until the sun set, until we had memorized everything from the color of her ponytail holder to the pattern of fringe on her bikini. Until we couldn't be sure we were seeing her clearly anymore.

  *

  My mother let me have that picture of Anna. But I didn't frame it; I put it into an envelope and sealed it and stuffed it far back into a corner drawer of a filing cabinet. It's there, just in case one of these days I start to lose her.

  There might be a morning when I wake up and her face isn't the first thing I see. Or a lazy August afternoon when I can't quite recall anymore where the freckles were on her right shoulder. Maybe one of these days, I will not be able to listen to the sound of snow falling and hear her footsteps.

  When I start to feel this way I go into the bathroom and I lift up my shirt and touch the white lines of my scar. I remember how, at first, I thought the stitches seemed to spell out her name. I think about her kidney working inside me and her blood running through my veins. I take her with me, wherever I go.

  MY

  SISTER'S

  KEEPER

  JODI PICOULT

  A READERS CLUB GUIDE

  ABOUT THIS GUIDE

  The suggested questions are intended to help your reading group find new and interesting angles and topics for discussion for Jodi Picoult's My Sister's Keeper. We hope that these ideas will enrich your conversation and increase your enjoyment of the book.

  Many fine books from Washington Square Press feature Readers Club Guides. For a complete listing, or to read the Guides online, visit https://www.BookClubReader.com.

  A CONVERSATION WITH JODI PICOULT

  Q: Your novels are incredibly relevant because they deal with topics that are a part of the national dialogue. Stem cell research and "designer babies" are issues that the medical community (and the political community) seems to be torn about. Why did you choose this subject for My Sister's Keeper? Did writing this novel change any of your views in this area?

  A: I came across the idea for this novel through the back door of a previous one, Second Glance. While researching eugenics for that book, I learned that the American Eugenics Society--the one whose funding dried up in the 1930s when the Nazis began to explore racial hygiene too--used to be housed in Cold Spring Harbor, New York. Guess who occupies the same space today? The Human Genome Project . . . which many consider "today's eugenics." This was just too much of a coincidence for me, and I started to consider the way this massive, cutting-edge science we're on the brink of exploding into was similar to--and different from--the eugenics programs and sterilization laws in America in the 1930s. Once again, you've got science that is only as ethical as the people who are researching and implementing it--and once again, in the wake of such intense scientific advancement, what's falling by the wayside are the emotions involved in the case-by-case scenarios. I heard about a couple in America that successfully conceived a sibling that was a bone-marrow match for his older sister, a girl suffering from a rare form of leukemia. His cord blood cells were given to the sister, who is still (several years later) in remission. But I started to wonder . . . what if she ever, sadly, goes out of remission? Will the boy feel responsible? Will he wonder if the only reason he was born was because his sister was sick? When I started to look more deeply at the family dynamics and how stem cell research might cause an impact, I came up with the story of the Fitzgeralds. I personally am pro stem cell research--there's too much good it can to do simply dismiss it. However, clearly, it's a slippery slope, and sometimes researchers and political candidates get so bogged down in the ethics behind it and the details of the science that they forget completely we're talking about humans with feelings and emotions and hopes and fears . . . like Anna and her family. I believe that we're all going to be forced to think about these issues within a few years, so why not first in fiction?

  Q: In Jesse, you've done an amazing job of bringing the voice of the "angry young man" alive with irreverent originality. Your ability to transcend gender lines in your writing is seemingly effortless. Is this actually the case, or is writing from a male perspective a difficult thing for you to do?

  A: I have to tell you--writing Jesse is the most fun I've had in a long time. Maybe at heart I've always wanted to be a seventeen-year-old juvenile delinquent, but for whatever reason, it was just an absolute lark to take someone with so much anger and hurt inside him and give him voice. It's always more fun to pretend to be someone you aren't, for whatever reason--whether that means male, or thirteen, or neurotic, or suicidal, or any of a dozen other first-person narrators I've created. Whenever I try on a male voice--like Jesse's or Campbell's or Brian's--it feels like slipping into a big overcoat. It's comfortable there, and easy to get accustomed to wearing . . . but if I'm not careful, I'll slip and show what I've got on underneath.

  Q: On page 190, Jesse observes, while reminiscing on his planned attempt to dig to China, that "Darkness, you know, is relative." What does this sentiment mean and why did you choose to express it through Jesse, who in some ways is one of the least reflective characters in the novel?

  A: Well, that's exactly why it has to be Jesse who says it. To Jesse, whatever injustices he thinks he's suffered growing up will always pale to the Great Injustice of his sister being sick. He can't win, plain and simple, so he doesn't bother to try. When you read Jesse, you think you see exactly what you're getting: a kid who's gone rotten to the core. But I'd argue that in his case, you're dealing with an onion . . . someone whose reality is several layers away from what's on the surface. The question isn't whether Jesse's bad, it's what made him that way in the first place and whether that's really who he is, or just a facade he uses to protect a softer self from greater disappointment.

  Q: How did you choose which quotes would go at the beginning of each section? Milton, Shakespeare, D. H. Lawrence--are these some of your favorite authors, or did you have other reasons for choosing them?

  A: I suppose I could say that all I ever read are the Masters, and that these quotes just popped out of my memory--but I'd be lying! The bits I used at the beginning of the sections are ones that I searched for, diligently. I was looking for allusions to fire, flashes, stars--all imagery that might connect a family that is figuratively burning itself out.

  Q: Sisterhood--and siblinghood, for that matter--is a central concept in this work. Why did you make Isobel and Julia twins? Does this plot point somehow correspond with the codependence between Kate and Anna? What did you hope to reveal about sisterhood through this story?


  A: I think there is a relationship between sisters that is unlike other sibling bonds. It's a combination of competition and fierce loyalty, which is certainly evident in both sets of sisters in this book. The reason Izzy and Julia are twins is because they started out as one embryo, before splitting in utero, and as they grew, their differences became more pronounced. Kate and Anna, too, have genetic connections, but unlike Izzy and Julia, they aren't able to separate from each other to grow into distinct individuals. I wanted to hold up both examples to the reader, so that they could see the difference between two sisters who started out as one and diverged, and two sisters who started out distinct from each other and somehow became inextricably tangled.

  Q: Anyone who has watched a loved one die (and anyone with a heart in their chest) would be moved by the heartfelt, realistic, and moving depiction of sickness and death that is presented in this story. Was it difficult to imagine that scenario? How did you generate the realistic details?

  A: It's always hard to imagine a scenario where a family is dealing with intense grief, because naturally you can't help but think of your own family going through that sort of hell. When researching the book, I spoke to children who had cancer, as well as their parents--to better capture what it felt like to live day by day and maintain a positive attitude in spite of the overwhelming specter of what might be just around the corner. To a lesser extent, I also drew on my own experience, as a parent with a child who faced a series of surgeries: when my middle son, Jake, was five, he was diagnosed with bilateral cholesteatomas in his ears--benign tumors that will eventually burrow into your brain and kill you, if you don't manage to catch them. He had ten surgeries in three years, and he's tumor-free now. Clearly, I wasn't facing the same urgent fears that the mom of a cancer patient faces, but it's not hard to remember how trying those hospitalizations were. Every single time I walked beside his gurney into the OR, where I would stay with him while he was anesthetized, I'd think, "Okay, just take my ear; if that keeps him from going through this again." That utter desperation and desire to make him healthy again became the heart of Sara's monologues . . . and is the reason that I cannot hate her for making the decisions she did.